Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
FOAM DRG >16<=48 SQ IN W/BDR
Low
$0
Average
$79
Median
$32
High
$836
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
212 hospitals; the 90th percentile is 17.2× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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271 hospital rates
iThe hospitals that file a Cigna rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Texas Health Arlington Memorial Hospital Arlington, TX percent of total billed charges · outpatientfrom % of charges | 3 | $27 | $73 | $106 | 146% | 12–120 | $10 – $499 |
| 2 | Tanner Medical Center - Carrollton Carrollton, GA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $46 | $46 | — | — | 10–100 | $46 – $46 |
| 3 | Tufts Medical Center BOSTON, MA percent of total billed charges · bothfrom % of charges | 1 | $9 | $15 | $10 | 70% | 8–80 | $5 – $30 |
| 4 | HOLLAND COMMUNITY HOSPITAL Holland, MI percent of total billed charges · outpatientfrom % of charges | 1 | $14 | $14 | — | — | 1–10 | $14 – $14 |
| 5 | John Muir Health Concord, CA percent of total billed charges · bothfrom % of charges | 3 | $124 | $140 | $24 | 17% | 1–10 | $124 – $174 |
| 6 | AHS Cushing Hospital, LLC Cushing, OK facility · percent of total billed charges · bothfrom % of charges | 1 | $23 | $29 | $15 | 51% | — | $15 – $49 |
| 7 | AHS Henryetta Hospital, LLC Henryetta, OK facility · percent of total billed charges · bothfrom % of charges | 1 | $24 | $24 | $3 | 14% | — | $20 – $27 |
| 8 | AHS Pryor Hospital, LLC Pryor, OK facility · percent of total billed charges · bothfrom % of charges | 1 | $22 | $23 | $1 | 6% | — | $21 – $24 |
| 9 | AHS Southcrest Hospital, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges | 1 | $19 | $22 | $13 | 59% | — | $8 – $46 |
| 10 | AMH Cath Labs LLC Arlington, TX percent of total billed charges · inpatientfrom % of charges | 1 | $36 | $94 | $132 | 141% | — | $17 – $499 |
| 11 | AMH Cath Labs LLC Arlington, TX percent of total billed charges · outpatientfrom % of charges | 3 | $27 | $73 | $106 | 146% | — | $10 – $499 |
| 12 | ANGEL MEDICAL CENTER Franklin, NC percent of total billed charges · outpatientfrom % of charges | 4 | $8 | $10 | $2 | 24% | — | $8 – $14 |
| 13 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH case rate · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 14 | Abbeville Area Medical Center Abbeville, SC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 15 | Adena Fayette Medical Center Washington Court House, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $74 | $74 | — | — | — | $74 – $74 |
| 16 | Adena Fayette Medical Center Washington Court House, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $74 | $74 | — | — | — | $74 – $74 |
| 17 | Adena Health System Chillicothe, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $63 | $63 | — | — | — | $63 – $63 |
| 18 | Adena Health System Chillicothe, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $63 | $63 | — | — | — | $63 – $63 |
| 19 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 20 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 21 | Athens Hospital, LLC Athens, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $63 | $80 | $67 | 84% | — | $8 – $169 |
| 22 | Aurora BayCare Medical Center Green Bay, WI percent of total billed charges · inpatientfrom % of charges | 1 | $49 | $49 | $11 | 22% | — | $38 – $60 |
| 23 | Aurora BayCare Medical Center Green Bay, WI percent of total billed charges · outpatientfrom % of charges | 2 | $45 | $46 | $11 | 23% | — | $34 – $60 |
| 24 | Aurora Lakeland Medical Center Elkhorn, WI percent of total billed charges · inpatientfrom % of charges | 1 | $38 | $34 | $22 | 64% | — | $8 – $63 |
| 25 | Aurora Lakeland Medical Center Elkhorn, WI percent of total billed charges · outpatientfrom % of charges | 2 | $36 | $32 | $21 | 65% | — | $7 – $63 |
← Payers reporting HCPCS A6213 · Snapshot 20261111T120946Z-9134e7f7